动态颅内压监测对去骨瓣减压术后重度高血压脑出血患者预后的影响
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摘要
目的研究动态颅内压监测对去骨瓣减压术后重度高血压脑出血患者预后的影响。方法选取登封市人民医院2013-12—2015-12治疗的重度高压脑出血患者68例,所有患者行去骨瓣减压术,根据患者入院顺序编号,采用随机数表法分为观察组与对照组,每组34例,观察组患者进行动态颅内压监测。比较2组术后甘露醇使用剂量、住院时间、术后并发症发生率及病死率,以及治疗前后白介素-6(IL-6)、超敏C反应蛋白(hs-CRP)、神经元特异性烯醇化酶(NSE)等血清生化指标水平;应用日常生活能力评分表(ADL)评定患者远期预后。结果观察组术后甘露醇使用总剂量较对照组小,住院时间较对照组短(P<0.05);观察组术后并发症发生率29.41%,较对照组的55.88%明显降低(P<0.05);术后10 d观察组IL-6、hs-CRP、NSE等血清生化指标水平较对照组低(P<0.05);观察组术后半年ADLⅠ～Ⅱ级患者占75.76%,较对照组的48.28%明显较高(P<0.05)。结论对行去骨瓣减压术的重度高血压脑出血患者实施动态颅内压监测,能及时发现病情变化,有效应用药物降压,降低了患者术后并发症发生率,改善远期预后。
Objective To study the effect of dynamic intracranial pressure monitoring on the prognosis of patients with severe hypertensive cerebral hemorrhage after decompressive craniectomy.Methods Sixty-eight patients with severe hypertensive cerebral hemorrhage who were admitted to the hospital between December 2013 and December 2015 were studied.All patients underwent decompressive craniectomy.According to the order of admission,the patients were numbered and were randomly divided into the observation group and the control group by the random number table method,34 cases in each group.The observation group were given dynamic intracranial pressure monitoring,while the control group were not monitored.The dosage of mannitol after operation,length of hospital stay,incidence rates of postoperative complications,mortality rates,the levels of interleukin-6(IL-6),high-sensitivity C reactive protein(hs-CRP),neuron specific enolase(NSE) and other serum biochemical indexes were compared between the two groups.The long-term prognosis of patients was evaluated with activities of daily living scale(ADL).Results The total dose of mannitol in observation group after operation was significantly less than the control group,and the length of hospital stay was significantly shorter than the control group(P<0.05).The incidence rate of postoperative complications in the observation group(29.41%) was significantly lower than that in the control group(55.88%)(P<0.05).10 d after operation,the levels of serum biochemical indexes(IL-6,hs-CRP,NSE) were significantly lower than those in the control group(P<0.05).Six months after operation,the probability of grade I-II ADL in the observation group(75.76%) was significantly higher than that in the control group(48.28%)(P<0.05).Conclusion The application of dynamic monitoring of intracranial pressure in patients with severe hypertensive cerebral hemorrhage after decompressive craniectomy can timely find the changes of patient's condition,and the effective use of antihypertensive drugs can reduce the incidence rate of postoperative complications,and improve the long-term prognosis of patients.
Objective To study the effect of dynamic intracranial pressure monitoring on the prognosis of patients with severe hypertensive cerebral hemorrhage after decompressive craniectomy.Methods Sixty-eight patients with severe hypertensive cerebral hemorrhage who were admitted to the hospital between December 2013 and December 2015 were studied.All patients underwent decompressive craniectomy.According to the order of admission,the patients were numbered and were randomly divided into the observation group and the control group by the random number table method,34 cases in each group.The observation group were given dynamic intracranial pressure monitoring,while the control group were not monitored.The dosage of mannitol after operation,length of hospital stay,incidence rates of postoperative complications,mortality rates,the levels of interleukin-6(IL-6),high-sensitivity C reactive protein(hs-CRP),neuron specific enolase(NSE) and other serum biochemical indexes were compared between the two groups.The long-term prognosis of patients was evaluated with activities of daily living scale(ADL).Results The total dose of mannitol in observation group after operation was significantly less than the control group,and the length of hospital stay was significantly shorter than the control group(P<0.05).The incidence rate of postoperative complications in the observation group(29.41%) was significantly lower than that in the control group(55.88%)(P<0.05).10 d after operation,the levels of serum biochemical indexes(IL-6,hs-CRP,NSE) were significantly lower than those in the control group(P<0.05).Six months after operation,the probability of grade I-II ADL in the observation group(75.76%) was significantly higher than that in the control group(48.28%)(P<0.05).Conclusion The application of dynamic monitoring of intracranial pressure in patients with severe hypertensive cerebral hemorrhage after decompressive craniectomy can timely find the changes of patient's condition,and the effective use of antihypertensive drugs can reduce the incidence rate of postoperative complications,and improve the long-term prognosis of patients.
引文
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[3] DING W,GU Z,SONG D,et al.Development and validation of the hypertensive intracerebral hemorrhage prognosis models[J].Medicine (Baltimore),2018,97(39):e12446.
[4] YANG Q,ZHUANG X,PENG F,et al.Relationship of plasma matrix metalloproteinase-9 and hematoma expansion in acute hypertensive cerebral hemorrhage[J].Int J Neurosci,2016,126(3):213-218.
[5] HERWEH C,NORDLOHNE S,SYKORA M,et al.Climatic and Seasonal Circumstances of Hypertensive Intracerebral Hemorrhage in a Worldwide Cohort[J].Stroke,2017,48(12):3 384-3 386.
[6] 中华神经科学会.脑血管疾病分类、诊断要点、神经功能缺损评分标准[J].中华神经科杂志,1996,29(6):376-383.
[7] ZENG J Y,LI S Y,ZHUANG W B,et al.Effects of intubating laryngeal mask airway in prevention of extubation responses in patients with hypertensive cerebral hemorrhage during general anesthesia recovery period[J].Zhonghua Yi Xue Za Zhi,2016,96(16):1 281-1 284.
[8] 邹志浩,张世忠,张文德,等.无创颅内压监测在早期预警高血压脑出血后血肿扩大中的意义[J].中华神经外科杂志,2013,29(1):50-53.
[9] 李想,陈新生.持续有创颅内压监测在高血压脑出血治疗中的应用[J].安徽医药,2013,17(5):825-827.
[10] YU S X,ZHANG Q S,YIn Y,et al.Continuous monitoring of intracranial pressure for prediction of postoperative complications of hypertensive intracerebral hemorrhage[J].Eur Rev Med Pharmacol Sci,2016,20(22):4 750-4 755.
[11] YANG G,SHAO G.Clinical effect of minimally invasive intracranial hematoma in treating hypertensive cerebral hemorrhage[J].Pak J Med Sci,2016,32(3):677-681.
[12] 史忠岚,袁绍纪,李博,等.连续动态颅内压监测在脑出血治疗中的应用评价[J].中华神经外科疾病研究杂志,2014,13(3):252-254.
[13] PASI M,MARINI S,MOROTTI A,et al.Cerebellar Hematoma Location:Implications for the Underlying Microangiopathy[J].Stroke,2018,49(1):207-210.
[14] YE Z,AI X,HU X,et al.Comparison of neuroend-oscopic surgery and craniotomy for supratentorial hypertensive intracerebral hemorrhage:A meta-analysis[J].Medicine (Baltimore),2017,96(35):e7876.
[15] LIANG K S,DING J,YIN C B,et al.Clinical study on minimally invasive liquefaction and drainage of intracerebral hematoma in the treatment of hypertensive putamen hemorrhage[J].Technol Health Care,2017,25(6):1 061-1 071.
[16] WANG W,ZHOU N,WANG C.Minimally Invasive Surgery for Patients with Hypertensive Intracerebral Hemorrhage with Large Hematoma Volume:A Retrospective Study[J].World Neurosurg,2017,105:348-358.
[17] FU C,LIU L,CHEN B,et al.Risk Factors for Poor Outcome in Hypertensive Intraventricular Hemorrhage Treated by External Ventricular Drainage with Intraventricular Fibrinolysis[J].World Neurosurg,2017,102:240-245.
[18] ZHAO Z H,ZHONG X M,WANG Y Q,et al.The clinical application of retractorless surgery in patients with hypertensive basal ganglia hemorrhage[J].Zhonghua Yi Xue Za Zhi,2017,97(9):666-669.
[19] DING R,LIN C,WEI S,et al.Therapeutic Benefits of Mesenchymal Stromal Cells in a Rat Model of Hemoglobin-Induced Hypertensive Intracerebral Hemorrhage[J].Mol Cells,2017,40(2):133-142.
[20] ZHANG H T,YU M,REN Y F,et al.Effect of different blood pressure control targets within 48 h after hypertensive cerebral hemorrhage on hematoma enlargement and prognosis[J].Nan Fang Yi Ke Da Xue Xue Bao,2016,36(12):1 616-1 620.
[21] FENG Y,HE J,LIU B,et al.Endoscope-Assisted Keyhole Technique for Hypertensive Cerebral Hemorrhage in Elderly Patients:A Randomized Controlled Study in 184 Patients[J].Turk Neurosurg,2016,26(1):84-89.
[22] RASRAS S,SAFARI H,ZEINALI M,et al.Decompressive hemicraniectomy without clot evacuation in supratentorial deep-seated intracerebral hemorrhage[J].Clin Neurol Neurosurg,2018,174:1-6.DOI:10.1016/j.clineuro.2018.08.017.
[23] HADJIATHANASIOU A,SCHUSS P,ILIC I,et al.Decompressive craniectomy for intracerebral haematoma:the influence of additional haematoma evacuation[J].Neurosurg Rev,2018,41(2):649-654.DOI:10.1007/s10143-017-0909-x.
[24] SATTER A R,ISLAM M R,HAQUE M R,et al.Comparison between Decompressive Craniectomy with Durotomy and Conservative Treatment in Spontaneous Supratentorial Intracerebral Hemorrhage[J].Mymensingh Med J,2016,25(2):316-325.
[25] MOUSSA W M,KHEDR W.Decompressive craniectomy and expansive duraplasty with evacuation of hypertensive intracerebral hematoma,a randomized controlled trial[J].Neurosurg Rev,2017,40(1):115-127.DOI:10.1007/s10143-016-0743-6.
[26] TAKEUCHI S,TAKASATO Y,MASAOKA H,et al.Decompressive craniectomy for arteriovenous malformation-related intracerebral hemorrhage[J].J Clin Neurosci,2015,22(3):483-487.DOI:10.1016/j.jocn.2014.08.033.
[27] ESQUENAZI Y,SAVITZ S I,EL KHOURY R,et al.Decompressive hemicraniectomy with or without clot evacuation for large spontaneous supratentorial intracerebral hemorrhages[J].Clin Neurol Neurosurg,2015,128:117-122.DOI:10.1016/j.clineuro.2014.11.015.
[28] TAKEUCHI S,TAKASATO Y,MASAOKA H,et al.Decompressive craniectomy with hematoma evacuation for large hemispheric hypertensive intracerebral hemorrhage[J].Acta Neurochir Suppl,2013,118:277-279.DOI:10.1007/978-3-7091-1434-6_53.
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